Clark Jillian M, Marshall Ruth
South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Lightsview, South Australia, Australia.
Centre for Orthopaedics and Trauma Research, University of Adelaide, South Australia, Australia.
Top Spinal Cord Inj Rehabil. 2017 Fall;23(4):353-367. doi: 10.1310/sci2304-353.
Non-traumatic SCI (NTSCI) etiologies represent a markedly heterogeneous cluster of conditions defined within the consensus NTSCI taxonomy. This meta-analysis assembles evidence about the occurrence of NTSCI and its clinical outcomes with respect to 6 research domains. To investigate the quality and quantity of clinical NTSCI evidence published in the peer reviewed literature with reference to prognosis, diagnosis, intervention, process of care, methodology, and qualitative approaches. : PubMed and MEDLINE OVID MeSH heading searches were conducted for 5 common-language NTSCI descriptors. Filters were English language and Entrez date (1997-2016). Filters also controlled for case reports, editorials or errata, and invited reviews. NTSCI etiologies incorrectly classified, animal studies, and multidimensional mapping studies were excluded. Full texts were retrieved and ranked for evidence quality according to PRISMA statement guidelines, or PEDro criteria. Data were extracted and simple descriptive statistics applied. The search terms non traumatic and non-traumatic SCI retrieved 282 articles, with 39 duplicates. After exclusion of 117 articles: Level 1V (60); NTSCI incorrectly evaluated (14); publication bias (2); non-English language (1); and animal experiments (1), 126 titles/abstracts were screened and ranked against criteria. Of the 8 papers allocated for full-text review, a subset of 3 articles was ranked level 1A (1) or level 11A (2); mean PEDro score 5.75±0.5. Reasons for full-text exclusions (5) were NTSCI incorrectly classified (1) and statistical limitations (4). Of the 6 domains, prognostics had adequate data yield (86) for evidence synthesis (4.8% ranked level 1A, or 11A). Notable evidence gaps were identified in qualitative (1), methodological (2), and diagnostic (8) domains. Therapeutic approaches require an evidence-based understanding of the distinct contexts in which NTSCI occurs, especially in less resourced settings. Our findings underscore the need for qualitative and quantitative research on the occurrence of NTSCI in all contexts.
非创伤性脊髓损伤（NTSCI）的病因代表了在共识性NTSCI分类法中定义的一组明显异质性的病症。这项荟萃分析收集了有关NTSCI的发生及其在6个研究领域的临床结局的证据。旨在参考预后、诊断、干预、护理过程、方法学和定性方法，调查同行评审文献中发表的临床NTSCI证据的质量和数量。对PubMed和MEDLINE OVID MeSH主题词进行了搜索，以查找5个通用语言的NTSCI描述符。筛选条件为英语和Entrez日期（1997 - 2016年）。筛选条件还控制了病例报告、社论或勘误以及特邀综述。排除分类错误的NTSCI病因、动物研究和多维映射研究。根据PRISMA声明指南或PEDro标准检索全文并对证据质量进行排名。提取数据并应用简单的描述性统计。搜索词“非创伤性”和“非创伤性脊髓损伤”检索到282篇文章，其中39篇重复。排除117篇文章后：IV级（60篇）；NTSCI评估错误（14篇）；发表偏倚（2篇）；非英语语言（1篇）；动物实验（1篇），对126篇标题/摘要进行了筛选并根据标准进行排名。在分配进行全文审查的8篇论文中，有3篇文章的子集被评为1A级（1篇）或IIA级（2篇）；平均PEDro评分为5.75±0.5。全文排除的原因（5篇）是NTSCI分类错误（1篇）和统计局限性（4篇）。在6个领域中，预后有足够的数据产量（86篇）用于证据综合（4.8%评为1A级或IIA级）。在定性（1个）、方法学（2个）和诊断（8个）领域发现了明显的证据空白。治疗方法需要基于证据来理解NTSCI发生的不同背景，尤其是在资源较少的环境中。我们的研究结果强调了在所有背景下对NTSCI的发生进行定性和定量研究的必要性。
